Headache and Non-traumatic Brain Bleeding

Question 1

List red flag symptoms/signs related to headache

Answer 1

New onset in over 55 yr old
Known/previous cancer
Immunosuppressed
Early morning onset
Exacerbated by valsalva

Question 2

What is the difference between migraine with and without aura? Which is more common?

Answer 2

Migraine with aura: warning signs before migraine begins, e.g. flashing lights
Migraine without aura is more common

Question 3

How long do auras typically last in migraine?

Answer 3

20-60 mins

Question 4

List triggers of migraine

Answer 4

Sleep
Diet
Stress
Physical exertion
Hormones

Question 5

List non-pharmacological treatment for migraine

Answer 5

Trigger diary
Education
Stress management

Question 6

List pharmacological management of migraine

Answer 6

NSAID + anti-emetic if vomiting

Triptans (rizatriptan)

Question 7

When should prophylaxis be considered for migraine?

Answer 7

More than 3 attacks in a month or very severe

Question 8

List prophylactic therapy for migraine

Answer 8

Propranolol
Topiramate
Amitryptilline
Gabapentin
Sodium valproate

Question 9

List the 4 main types of trigeminal cephalgias

Answer 9

Cluster headache
Paroxysmal hemicranias continua
Hemicrania continua
SUNCT

Question 10

Who gets cluster headaches more - men or women?

Answer 10

Men

Typically 30-40 yr olds

Question 11

When do cluster headaches typically come on?

Answer 11

Around sleep time

Question 12

Describe a cluster headache

Answer 12

Severe unilateral headache lasting 20mins-3hrs

1 to 8 episodes a day

Question 13

Who gets paroxysmal hemicranias continua more - men or women?

Answer 13

Women

Typically 50-60 yr olds

Question 14

How would you distinguish paroxysmal hemicranias continua from cluster headache?

Answer 14

Shorter duration, more frequent

2-45 minutes 1-40 times a day

Question 15

Which drug provides absolute response to paroxysmal hemicranias continua?

Answer 15

Indomethicin

Question 16

What is a SUNCT trigeminal cephalgia?

Answer 16

Short
Unilateral
Neuralgia
Conjunctival injections
Tearing

Question 17

What is the treatment for SUNCT?

Answer 17

Gabapentin / lamotrigine

Question 18

Who gets trigeminal neuralgia more - men or women?

Answer 18

Women

Typically elderly

Question 19

What typically triggers trigeminal neuralgia?

Answer 19

Touch in V2/V3 region

Question 20

How long does an episode of trigeminal neuralgia usually last?

Answer 20

1-90 seconds

10-100 episodes a day

Question 21

List treatment for trigeminal neuralgia

Answer 21

Carbamazepine
Gabapentin
Phenytoin
Baclofen
Surgical decompression

Question 22

What is the most common underlying pathology in a subarachnoid haemorrhage?

Answer 22

Berry aneurysm (polycystic kidney disease)

Question 23

Subarachnoid haemorrhage can occur whilst having sex. True/False?

Answer 23

True

Question 24

Which cranial nerve can be particularly affected in subarachnoid haemorrhage?

Answer 24

CN III

Question 25

What may be seen on fundoscopy in someone who has had a subarachnoid haemorrhage?

Answer 25

Retinal or vitreous haemorrhage

Question 26

CT scan of a brain may be normal in subarachnoid haemorrhage. True/False?

Answer 26

True

Question 27

If a CT scan of a person with suspected subarachnoid haemorrhage is normal, what is the next best investigation?

Answer 27

Lumbar puncture

Question 28

Describe CSF appearance on lumbar puncture in subarachnoid haemorrhage

Answer 28

Xanthochromatic or bloodstained

Question 29

What investigation is gold-standard for identifying bleeding location of a subarachnoid haemorrhage?

Answer 29

Cerebral angiography with/without CT

Question 30

List some complications of subarachnoid haemorrhage

Answer 30

``` Re-bleeding often fatal Hydrocephalus Hyponatraemia Seizure Delayed ischaemia - 3-14 days following haemorrhage ```

Question 31

Why should you not fluid restrict someone with hyponatraemia as a complication of subarachnoid haemorrhage?

Answer 31

Will cause hypovolaemia, predisposing to vasospasm and cerebral ischaemia

Question 32

What is the most common aetiology/risk factor for intracerebral haemorrhage?

Answer 32

Hypertension leading to microaneurysm

Question 33

Typically where does a hypertensive intracerebral haemorrhage affect anatomically?

Answer 33

Basal ganglia (haematoma)

Question 34

List the main investigations for intracerebral haemorrhage

Answer 34

``` CT scan (urgent if decreased consciousness) Angiography ```

Question 35

Arteriovenous malformations (AVMs) are typically clinically silent. True or false?

Answer 35

True - they are clinically silent until haemorrhage

Question 36

Where is the bleeding in a subarachnoid haemorrhage?

Answer 36

Bleeding in the subarachnoid space between the pia and arachnoid membrane

Question 37

If a subarachnoid haemorrhage shows up on CT is shows up as a ____ signal in the subarachnoid space?

Answer 37

Hyperdense

Question 38

Which well circumscribed benign vascular lesion shows up as a focal lesion with a “popcorn-like” appearance surrounded by a ring of hypo-intensity consistent with hemosiderin deposition on MRI?

Answer 38

Cavernous malformation

Question 39

Most aneurysms arise in the posterior circulation. True or false?

Answer 39

False - 90% arise from the anterior circulation

Question 40

Intracerebral haemorrhage always causes focal neurological deficits. True or false?

Answer 40

True

Question 41

Idiopathic intercranial hypertension typically affects what type of patient?

Answer 41

Young, obese females